Immunodeficiency in the lupus clinic

Systemic lupus erythematous (SLE) and immunodeficiency are linked in various ways. For example, rare genetic complement deficiencies can pre-dispose to developing SLE, whilst some treatments for SLE can cause secondary immunodeficiencies. Various case reports describe SLE patients who have concomitant or later develop antibody deficiency, possibly related to immunosuppressive treatment, or possibly related to the lupus itself. Other components of the immune system, innate and adaptive may also be affected. Immunosuppressive treatment may also cause infections in the absence of defects on routine immunological testing. It is important for the clinician to be aware of the associations between SLE and immunodeficiency to ensure optimal investigation and management. This review focuses on aspects of humoral and cellular immunity, and their association with SLE.